Welcome to our new pain management forum

I am glad for the opportunity to read experiences with pain management. Angelbear, I also have chronic pain and have always kept my personal experience in mind when dealing with my clients. Now my question; We have been 'burned' on more than one occasion by chemically dependent clients who are drug seeking. We tend to take a patient's word for it that they are in pain. There is little literature on judging the truth of what is and what is not pain. The problem lies in our complicity in continuing a client's addictive behavior, not to mention their habit, while trying to help them get free of their addiction. Would appreciate any comments on this subject. JudyP

I think whoever thought of the 0-10 pain scale ought to be shot. It is ssoooooooo inaccurate. Of course pain is subjective but when someone is eating potato chips and drinking a coke their pain can't possible be a 10/10. I have even tried to explain to patients that a 10 is like childbirth or having someone cut off your arm without anesthesia and they'll still say "10"! On the other hand I'll get a man with acute MI and he'll rate his pain as 1 or 2 as his face grimaces and he is diaphoretic. Any other thoughts on the pain scale?

Personally if I were to come across someone I thought was a drug seeker I would assume their pain is legit and not being adequetly treated and would advocate to refer to pain specialist. If I suspected a true drug addict I would advocate for a pshyc consult or drug treatment consult. Whatever the case may be the pt deserves appropriate and compassionate care.

Completely agree Angelbear. Too bad we don't have more educated and caring professionals working in pain treatment.

Dave

I'm glad for this forum. I try to remember that pain is subjective, but to be honest it gets hard sometimes. I'm glad to have this place, to keep me compassionate.


The only time I've asked an md to d/c a pain med was a young girl early 20's that asked for a demerol shot for a ha then as soon as I gave it looked at her boyfriend and said "I'm so high" He said "You need to stop this" Now I do think she was having pain and it needed management, just not iv demerol. She got switched to something not so strong and did fine.


I think PCA should be utilized more with "the clockwatchers" They could relieve their own pain and not have to wait.


Noney

Great forum to have, Brian.

As a former pre-op/post-op surgical floor nurse (many moons ago), I always loved teaching my patients about pain management from the day they were admitted to the hospital. It was very important for the patient to understand preoperatively how to manage their pain besides the medications they would be receiving to help with their pain relief.

That was the best floor to work on because I loved the teaching aspect, and being able to see what I taught my patients come to fruition in their post-op healing phase and recovery.

The patients who would come to the floor post-op without any pre-op teaching on pain or what to expect after their surgery were always the ones who were more frightened and had very little understanding of managing their pain, when to ask for their pain meds, and which pain meds were most effective.

Love this topic!

The only person qualified to dx. a pt with addiction is someone who specializes in addiction medicine.

Even if a person is an "addict," does that mean his pain should go untreated? Why is this country so puritanical about treating pain, when there are far worse addictive substances readily and legally available (like ETOH)?

Pain is whatever the pt says it is, and occurs whenever the pt says it does. People with chronic pain can look normal; I can tell you from personal exp. that few people know when I am in pain because I have gotten very skilled at masking it. Families get tired of hearing about it, and pts feel like they need to put on a "brave face."

If I have to choose between possibly medicating an "addict" (not my term) or not medicating a pt with pain, I'll err on the side of the former, every time.

Did anyone else see on the news or read in the paper about the doctor who is being accused of being "too pain management diligent" with her patients?

The doctor said that she evaluates each of her patients based on what they may need for pain management and has no real way of telling which patient is truly abusing their pain meds.

This doctor stands to lose her medical license over this.

Sounds like if we undermedicate, we're guilty, and if we overmedicate we're guilty.

What a great forum. I work in Rehab nursing and pain is a very real part of most of my patients' day. I have always thought it was sad to say a co-working is "addicted" to Vicoden or some such thing; usually they are talking about an 80 year old who just had a total hip replacement! I think the "clockwatchers" among our patients are not addicted--just scared to death of the pain. I think that as nurses we see so much pain and become somewhat desensitized to it. We need to be reminded every so often that pain is "what the patient says it is."

To Angelbear and Fab4fan, We do medicate with non-addicting meds. We know that pain is what a patient says it is. As a facility, we tend to either give everything or nothing. We have experienced patients who get surgery to obtain pain meds, and who have set fire to their legs, with cool deliberation on just how long to let it burn to destroy nerve endings, and then request the meds due to (our perception of) burn pain. Our chemical dependent units have substance abuse counselors, psychiatrists, and medical docs to help the patients. The Substance abuse counselors either buy the whole story and make sure that the guy who is drinking a coke and eating chips and claims a level 10, gets pain meds. Then other substance abuse counselors who the medical folks see (as being in great pain) who insist that 'He's drug seeking'. We were sent a patient who was on Duragesic patches, for treatment of his "prescription pain med abuse'. Can you see our dilemma? Our chemical abuse units wrestle with this question on a daily basis. We appreciate any thoughts on making an objective determination about pain.